BACKGROUND Partial cardiac sympathetic reinnervation after cardiac transplant has been extensively investigated and evidenced. However, there have been no large-scale, long-term studies evaluating the prevalence, time-course, and association with long-term survival of sympathetic reinnervation of the heart. METHODS Cardiac transplant recipients (n = 232) were recruited from outpatient clinic at a single transplant center in the United Kingdom. Participants were each tested once for the presence of sympathetic reinnervation of the sinus node using the low-frequency component of power spectral analysis of heart rate variability, with a cutoff defined as 2 standard deviations above the mean for denervated participants (those tested <56 days posttransplant). Time course was calculated based on the timing of testing posttransplant. Patients were then followed up over a period of up to 27 years after transplant for survival analysis. RESULTS The overall prevalence of cardiac sympathetic reinnervation in the 225 patients tested >56 days posttransplant was 64.9%. Sympathetic reinnervation primarily occurred in the first 18 months after transplant, with a plateau thereafter. The prevalence in participants tested >18 months posttransplant was 69.6%. In Kaplan-Meier survival analysis, sympathetic reinnervation was associated with significantly improved survival (Log-rank p = 0.019), with a median survival time for reinnervated patients of 19.9 years compared with 14.4 years for the denervated group. CONCLUSIONS Sympathetic reinnervation of the sinus node occurs mostly within 18 months of transplant, is found in 70% of cardiac transplant recipients tested >18 months posttransplant, and is associated with significantly improved long-term survival.

中文翻译：

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心脏移植受者的交感神经再支配：患病率、时间进程和与长期生存的相关性。


背景 心脏移植后部分心脏交感神经再支配已得到广泛研究和证据。然而，还没有大规模、长期的研究来评估心脏交感神经再支配的患病率、时间进程以及与长期生存的相关性。方法 心脏移植受者 （n = 232） 是从英国一个移植中心的门诊招募的。使用心率变异性功率谱分析的低频分量，参与者每人接受了一次窦房结交感神经再支配的测试，截止定义为比去神经支配参与者的平均值高 2 个标准差（移植后测试 <56 天的人）。根据移植后检测的时间计算时间。然后在移植后对患者进行长达 27 年的随访以进行生存分析。结果 移植后 >56 天检测的 225 例患者心脏交感神经再神经支配的总体患病率为 64.9%。交感神经再神经支配主要发生在移植后的前 18 个月，此后进入平台期。移植后 >18 个月测试的参与者患病率为 69.6%。在 Kaplan-Meier 生存分析中，交感神经再支配与生存率显着提高相关 （Log-rank p = 0.019），再神经支配患者的中位生存时间为 19.9 年，而去神经支配组为 14.4 年。结论 窦房结的交感神经再支配主要发生在移植后 18 个月内，在 70% 的心脏移植受者中发现 >移植后 18 个月检测，并且与长期生存率的显着提高相关。